Survey for Collecting RV Nose Gear Failures
All RV-A pilots fill out Section 1
Person with incident/accident info fill out Section 1&2.
I like to thanks you all for your contribution. Revision: 0.8
* Required
Section 1
For all RV-A pilots and incident incident/accident info.
Reporting
*
RV-A pilots report
Incident/accident data to report
Source
*
Select data source below
Pilot/Owner
First hand Knowledge
NTSB Report
Data Entry Person
Name
Enter your name not required
Your answer
Email Address
Your email address not required
Your answer
Aircraft registration #
*
Please enter the aircraft registration #
Your answer
Model
*
Select RV Model
Choose
RV-6A
RV-7A
RV-8A
RV-9A
RV-10A
RV-12A
RV-14A
Engine type
Select engine type
Choose
235
240
290
320
340
360
390
540
Auto conversions
Rotax 912
Rotax 913
Rotax 914
Other
Propeller type
Select propeller type
Choose
FP Wood
FP Metal
FP Composite
CS Metal
CS Composite
Other
Year placed in service
Enter year (format xxxx)
Your answer
Nose wheel bearing type
Select bearing type
Stock
Anti-Splat
Grove Wheel
Beringer
Matco
Other:
Clear selection
Nose skid plate device installed?
Select
No
Anti-Splat Lip Skid
Custom Skid Device
Clear selection
Nose gear leg reinforcement installed?
Select
No
Anti-Splat Nose Job
Wooden Stiffener
Some kind of glass wrap
Other:
Clear selection
Vans Service Bulletin 07-11-09 Fork Modification Done
Select
No
Yes
Aircraft Empty Weight in lbs
Your answer
Nose empty weight in lbs
Your answer
Rough tire pressures kept on the nose wheel in lbs
Your answer
Pilot name
Enter pilot name not required
Your answer
Pilot total time
Your answer
Pilot total time in type
Your answer
Landings on paved
# of RV-A landings on paved
Your answer
Landings on un-paved high quality
# of RV-A landings on un-paved high quality
Your answer
Landings on un-paved average quality
# of RV-A landings on un-paved average quality
Your answer
Landings on un-paved low quality
# of RV-A landings on un-paved low quality
Your answer
Section 2
for only person with incident/accident info on RV Nose Gear Failures.
Date
Approximate Date of incident
Date
Location
Runway Location identifier, name or city
Your answer
Gear fail type
How did the gear fail
Slight tuck under, no prop strike
Tuck under with prop strike
Flip Over
Other:
Clear selection
Surface type
Choose
Paved
Grass
Gravel
Dirt
Taxiway
Off airport
Surface condition
Choose
Dry
Wet
Muddy
Washboard
Rodent Holes
Surface quality
1 = Very rough 10 = Perfect
Low
1
2
3
4
5
6
7
8
9
10
High
Clear selection
Speed (mph)
Approximate speed in MPH at the time of the incident
Your answer
Flap position
At onset of incident
Choose
Full Flaps
Partial Flaps
No Flaps
Not sure
Braking action
At onset of incident
Choose
No Braking
Partial Flaps
Light Braking
Medium Braking
Heavy Braking
Stick position
At onset of incident
Choose
Centered
Slight aft
Medium aft
Medium Braking
Full aft
Not sure
Pilot Weight
Approximate amount of weight pilot
Your answer
Passenger Weight
Approximate amount of Passenger
Your answer
Baggage Rear Weight
Approximate amount of weight of Baggage Rear
Your answer
Baggage Front Weight
Approximate amount of weight of Baggage Front
Your answer
Time on plane
Approximate total time on plane at time of incident
Your answer
Nose wheel pant
Nose wheel pant on at the time of the incident
On
Off
NTSB ID
If available
Your answer
Pertinent info
Any details, or other pertinent information that you think might be useful?
Your answer
Submit
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